Series: Why You Are Still Here · Episode 19 · Pillar 4: Impact & Purpose
By Rod Gamble | Week 46, 2026 | Pillar 4: Impact & Purpose
A clinician can only see so many patients in a shift. The people who shape the system reach the rest.
I have spent more than twenty years in the space between the ward and the system. The worry I hear most from clinicians thinking about stepping away is rarely about workload. It is about standing.
The Question Underneath the Guilt
On public forums the same worry turns up in different words. A nurse who moved away from the bedside wrote in October 2024 that they felt guilty about not being “in the trenches” with old colleagues. A doctor weighing a non-clinical role wrote in November 2023 that clinical work has “direct impact that’s hard to find elsewhere.” Neither is arguing that the work doesn’t matter. They are asking who gets to say you still matter once you step away.
Look at what the data suggests people are actually leaving. In a 2022 Bain survey of 573 US clinicians, 25% were considering leaving healthcare entirely, yet 80% were satisfied with the quality of care they give. That is old, American data, so treat it as context rather than news. But the shape fits what I hear. Most people are not leaving the purpose. They are leaving the conditions, and the moral injury literature puts the harm there too, in the system rather than in the person.
So the honest answer is not “remember your calling.” Many of us are well past that, and I don’t blame anyone for it. The answer is closer to arithmetic.
What Happened in the First Week of October
On 6 October the government accepted all 44 recommendations of the National Commission into the Regulation of AI in Healthcare, a commission led by NHS doctors. In practice that means a move towards regulating AI medical devices across their working life rather than at a single approval, draft MHRA guidance on managing changes to adaptive AI by December, and a commitment to keep patients informed when AI is used in their care. A full implementation roadmap is due by Spring 2027.
The same week, Skin Analytics announced in its own release that its DERM tool will triage suspected skin cancer referrals across all 18 trusts in NHS England’s South East region, rolling out over three years. The performance figures and the benefits are the company’s and are partly modelled, so read them that way. And in Europe, a €20 million network called CHAIN, coordinated by the European Society of Cardiology, launched on 7 October to attach “AI passports” to validated cardiovascular tools, recording each tool’s performance, safety and suitability so hospitals can judge what to trust.
Different countries, different tools, one question: who decides how a tool is judged, how it is rolled out, and how it is explained to the patient in front of it? Software does not answer that. People do. A narrative review in BMJ Digital Health & AI this April argued that AI models can lose accuracy after go-live because real-world data shift, and that this should be treated as an expected part of a device’s life, monitored continuously. Monitoring is a job. Explaining to a patient is a job. Both go to someone.
Reach, Not Calling
Here is the turn. We tend to count impact one patient at a time, and by that count leaving the bedside looks like a loss. But a clinic list is a ceiling of its own. One clinician sees the patients on the list. The clinician who helps shape how a tool is judged, rolled out and explained touches every patient it reaches. That is not a step away from care. It is care in a bigger room.
I am not going to promise it feels more meaningful. A doctor on a public forum wrote that a non-clinical role lacked the meaning they had drawn from clinical work, and that is honest evidence worth respecting. Some of us should stay in the hospital, and some of us should move into digital health, and I think each is right for the people who choose it. My claim is narrower. If reach is what you miss, it is available, and the guilt about whether you are still a “real” nurse or doctor rests on a measure that was never the whole picture.
The Clinician in the Room
After more than twenty years of EPR programmes, the thing I trust most is the clinician in the room. A tool becomes safe practice because someone who understands the ward says “that won’t work at three in the morning” and is listened to. On an NHS go-live between 2015 and 2017 I learned the other half of that: the clinician in the room only helps if the room is protected.
The programme was under real political pressure, and the pressure kept landing on the analysts and clinical experts doing the work. So I told anyone leaning on my people to bring it to me instead. I took the fights that were aimed at me so the team could get on with the job. Someone started calling me Lightning Rod. The team delivered what the vendor described as the most successful go-live they had seen in Europe to that point.
Impact at scale, in my experience, is mostly making room for other people to do brilliant work. The skills it takes, advocacy, reading a room, staying calm while others escalate, are ones you practised on the ward long before anyone gave them a title.
Steps You Can Take Now
1. Read the government’s response to the National Commission (6 October) and find the one recommendation closest to your clinical work. Telling patients when AI is used and monitoring tools after go-live are two good places to start.
2. Write three lines: what that recommendation would change on your ward or in your clinic, and who should be in the room when it is put into practice.
3. Add one line on why you would want to be that person. This is not a vocation speech. It is plain evidence of the purpose you would bring.
4. Keep the note. It is useful whichever of us stays and whichever of us goes, and it is the start of a case for a digital role, written in your own words.
The list was only ever the part of the room you could see.
When you’re ready to talk, rodgamble.com is where to find me.
#CoachRod #HealthcareTransformation #healthcareleadership #patientoutcomes #systemchange #meaningfulwork #legacybuilding
References
1. GOV.UK. “Government backs recommendations of NHS doctors-led AI Commission” (6 October 2026). https://www.gov.uk/government/news/government-backs-recommendations-of-nhs-doctors-led-ai-commission
2. MHRA. “AI Airlock Phase 3: application.” GOV.UK. https://www.gov.uk/government/publications/ai-airlock-phase-3-application
3. Skin Analytics. “NHS England South East region to roll out AI for skin cancer checks” (6 October 2026). Company’s own release; performance figures are the company’s and benefits are modelled. https://skin-analytics.com/news/partner-news/nhse-south-east-region-roll-out-ai-for-skin-cancer-checks/
4. European Society of Cardiology. “From promise to patient impact: new European initiative aims to accelerate AI in cardiovascular care” (7 October 2026), launching CHAIN. https://www.escardio.org/news/press/press-releases/from-promise-to-patient-impact-new-european-initiative-aims-to-accelerate-ai-in-cardiovascular-care/
5. Rotalinti Y et al. “Identifying and understanding significant change due to drift when assessing AI models in healthcare: a narrative review.” BMJ Digital Health & AI 2026;2(1) (29 April 2026). https://bmjdigitalhealth.bmj.com/content/2/1/e000085
6. Becker’s Hospital Review. “Bain: 25% of clinicians want out of healthcare” (11 October 2022; survey of 573 US clinicians, July 2022). https://www.beckershospitalreview.com/workforce/bain-25-of-clinicians-want-out-of-healthcare.html
7. LaingBuisson. “Moral injury causing clinicians to quit profession” (25 September 2024). https://www.laingbuissonnews.com/healthcare-markets-content/news-healthcare-markets-content/moral-injury-causing-clinicians-to-quit-profession/
8. Public forum threads: allnurses, “Self Guilt Leaving Bedside” (October 2024) https://allnurses.com/self-guilt-leaving-bedside-t762648/ · Student Doctor Network, “Transitioning to the next career” (November 2023) https://forums.studentdoctor.net/threads/transitioning-to-the-next-career.1488338/
